class 9 hypertension, angina, MI Flashcards
what is stage 1 hypertension
130-139/80-89
what is stage 2 hypertension
> =140/>=90
what is hypertensive crisis
> 180/>120
what is primary or essential hypertension
hypertension resulting from an unknown cause
-gradual development
-most common
what is secondary hypertension
hypertension resulting from a known cause
-#1 cause is pregnancy
-once identified: tx and meds
what is isolated systolic hypertension (ISH)
when diastolic is normal but systolic is elevated
“white coat” hypertension
-needs to happen on many occasions to dx
nonmodifiable risk factors of HTN
-family history
-age
-gender
-ethnicity
modifiable risk factors of HTN
-diabetes
-dyslipidemia
-stress
-obesity
-high Na intake
-substance abuse
clinical manifestations of early stages hypertension
asymptomatic
clinical manifestations of hypertension
-headache
-fatigue
-dizziness
-palpitations
-flushing
-blurred vision
-epistaxis
patient assessment for HTN
-history and physical exam
-blood work/lab tests
-EKG
-Blood Pressure Monitoring (2 elevated readings)
Hypertension Management
-lifestyle modifications
-weight reduction
-sodium reduction
-dietary fat modification “DASH” diet
-decrease alcohol intake
-physical activity
-medication
medications are used to:
-reduce peripheral resistance
-decrease blood volume
-strengthen or increase the rate of contraction
types of medications used
-diuretics (K sparing/thiazide/loop)
-beta blockers
-ACE inhibitors (chronic cough)
-ARBs
-calcium channel blockers
-adrenergic blockers
-vasodilators
-may need cholesterol meds
consequences of hypertension
-left ventricular hypertrophy
-coronary artery disease
-angina
-MI
-heart failure
-CVA
-peripheral vascular disease
-retinopathy
-renal disease
nursing care for hypertension
-history and risk factors
-assess potential symptoms of target organ damage
-cardiovascular assessment
-medication education
potential symptoms of target organ damage
-angina
-SOB
-altered speech
-altered vision
-nosebleed
-headaches
-dizziness
-balance problems
-nocturia
what is hypertensive urgency
> 180/110
-no major organ damage
-BP must be lowered within a few hours
-stat dose of med ordered
what is hypertensive emergency
> 220/140
-management necessary to prevent/halt damage to target organs
-IV vasodilators & hooked up to monitor
what is athersclerosis
-abnormal accumulation of lipids in the arterial blood vessel walls
-blood flow is reduced
-leads to collateral circulation to prevent ischemic injury
what is angina
chest pain resulting from myocardial ischemia
-ischemia=pain
what is angina associated with
-athersclerosis
-blockage of coronary artery
-coronary artery spasm
what is stable angina (chronic)
exacerbated by activity & resolved with rest
what is unstable angina
pain continually gets worse & is not relieved with rest or nitroglycerin
what is intractable or refractory angina
severe reoccuring chest pain
what is variant angina (prinzmetal’s angina)
chest pain at rest due to vessel spasm
what is silent ischemia
no chest pain, doesn’t know ischemia is happening
what is microvascular angina
chest pain brought on by ischemia of the microvasculature in the heart
potential triggers for angina
-physical exertion
-temperature extremes
-emotions
-heavy meals
-tobacco use
-sexual activity
-stimulants
-circadian rhythm patterns
diagnostic testing for angina
-EKG
-exercise electrocardiograpthy (stress test)
-radioisotope imaging
-electron-beam computed tomography (CT)
-chest x-rays
-coronary angiography
-lab values
management for angina
-goal: decrease o2 demand of myocardium and increase o2 supply
-medications (vasodilators)
-control and reduce risk factors
medications given for angina
-morphine (dec pain & RR)
-o2
-nitro (may get headache)
-antiplatelet/anticoagulant
-beta blocker
-calcium channel blockers
nursing management for angina
-avoid activities which precipitate angina
-management of hypertension
-medication information
-exercise
-quit smoking
-weight loss
-stress reduction
what is acute myocardial infarction
-life threatening condition
-complete or almost total occlusion of coronary artery
-an abrupt cessation or decreased blood and o2 to the heart muscle
-prolonged ischemia leading to irreversible damage
what is acute coronary syndrome (ACS)
spectrum of acute myocardial infarction
what does ST-elevation myocardial infarction (STEMI) indicate
indicates possible necrosis of myocardial tissue
what does non-ST elevation myocardial infarction (NSTEMI) indicate
indicates ischemia of myocardial tissue
-allows for more time to treat/can manage with meds
cardiovascular s&s of myocardial infarction (heart attack)
-chest pain that radiates to jaw/arm
-palpitations
-increased Jugular vein distension
-HTN
-EKG changes
respiratory s&s of myocardial infarction (heart attack)
-SOB
-tachypnea
-crackles
-possible pulmonary edema
gastrointestinal s&s of myocardial infarction (heart attack)
-nausea and vomiting
-indigestion
skin s&s of myocardial infarction (heart attack)
-cool
-clammy
-diaphoretic
-pale appearance
genitourinary s&s of myocardial infarction (heart attack)
-decreased urine output
neurologic s&s of myocardial infarction (heart attack)
-anxiety
-restlessness
-lightheaded
psychological s&s of myocardial infarction (heart attack)
-fear
-impending doom
s&s of myocardial infarction (heart attack) in diabetes/women
-stomach pain/reflux/indgestion
-SOB
-dizziness
-nausea
diagnostic testing for myocardial infarction
-EKG
-PET scan
-MRI
-echocardiogram
-transesophageal echocardiography
-labs: CK-MB, myoglobin, tropoin, imaging studies
what is CK-MB
indicates muscle damage (inc with myocardial damage)
-may be increased after sugery
what is troponin
-protein found in heart muscle cells
-highly sensitive
-elevated indicates heart damage
-can differentiate STEMI or NSTEMI
treatment for myocardial infarction
-EKG
-labs asap
-aspirin, nitro, morphine, o2 (sats >92%)
-beta blockers
-ACE inhibitors
-Thrombolytic therapy
-bed rest
-maybe antilipid
what is afib
-common dysrhythmia
-contracting rapidly at an irregular, fast rate
-quivering leads to blood pooling in atria
risk factors for atrial fibrillation
-HTN
-diabetes
-obesity
-mitral valve disease
-heart failure
-obstructive sleep apnea
-hyperthyroid
-cardiac ischemia
-cardiac inflammatory disease
-myocardial hypertrophy, fibrosis, dilation
characteristics of afib
-irregular rhythm
-palpitations
-fatigue
-light-headed/syncope
what is paroxysmal afib
erratic heart rates begins suddenly and stops on its own before 7 days
what is persistent continuous afib
abnormal heart rhythm that lasts more than 7 days
what is long-standing persistent continuous afib
abnormal heart rhythm than last lasted longer than a year
what is permanent persistent afib
when abnormal heart rhythm is present all the time regardless of efforts to restore rhythm
what is non valvular afib
abnormal heart rhythm NOT due to valve involvement
diagnostic test for afib
-history and physical
-chets xray
-exercise stress test
-holter monitor
-EKG
-transthoracic echocardiogram (TEE)
-blood work
atrial and ventricular rate in untreated afib
atrial: 300-600 bpm
ventricular: 120-200 bpm
-highly irregular
QRS shapes and duration with afib
usually normal, may be abnormal
P wave with afib
-no discernible P waves; irregular undulating waves that vary in amplitude and shape are seen and referred to as fibrillatory or f waves
pr interval in afib
cannot be measured
treatment for afib
-depends on cause, pattern, and duration
-cardioversion
-antiarrhythmic medications
medical management of afib
-medication is based on risk of stroke
-anticoags
-antiplatelet
-calcium channel blocker
-beta blockers
-ACE inhibitors
-Angiotensin receptor blockers (ARBs)
-cholesterol lowering drugs
